NPIMap

Organization Active NPI

Paul J Super OD a Professional Corporation

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1457681371
Registry record updated Mar 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OP8867TPG Issued in CA
Legal business name
PAUL J SUPER OD A PROFESSIONAL CORPORATION
Practice address
11777 San Vicente Blvd
#130
Los Angeles, CA 90049-5011
Phone
(310) 820-2020
Fax
(310) 820-1884
NPI assigned
Dec 29, 2009
Last updated
Mar 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Paul J Super, O.D.NPI 1649499807
Title
Optometrist
Phone
(310) 820-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X OPT8867T CA
Optometrist 152W00000X OP8867TPG CA Primary
Corneal and Contact Management Optometrist 152WC0802X OP8867TPG CA
Low Vision Rehabilitation Optometrist 152WL0500X OP8867TPG CA
Pediatric Optometrist 152WP0200X OP8867TPG CA
Vision Therapy Optometrist 152WV0400X OP8867TPG CA

Addresses

Primary practice location

11777 San Vicente Blvd
#130
Los Angeles, CA 90049-5011

Mailing address

11777 San Vicente Blvd
#130
Los Angeles, CA 90049-5011
Phone (310) 820-2020

National Provider Directory

National Provider Directory

Locations

11696 San Vicente Blvd
Los Angeles, CA 90049
Phone (310) 820-2020

11777 San Vicente Blvd
Ste 130
Los Angeles, CA 90049
Phone (310) 820-2020

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1457681371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11777 SAN VICENTE BLVD",
            "address_2": "#130",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495011",
            "telephone_number": "310-820-2020",
            "fax_number": "310-820-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11777 SAN VICENTE BLVD",
            "address_2": "#130",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495011",
            "telephone_number": "310-820-2020",
            "fax_number": "310-820-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL J SUPER OD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-29",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "SUPER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "310-820-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "OPT8867T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OP8867TPG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "OP8867TPG",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "OP8867TPG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "OP8867TPG",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "CA",
            "license": "OP8867TPG",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.